New to urology: Op note codes

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I have recently started doing urology coding, and I'm wondering if I can code these together:


I know it will be hard to tell without an op note, but this office uses this combination on a weekly basis.

I know the 52353+52320 can be used together according to the CCI edits. 50590+52353 cannot be used together, according to the CCI edits, without an allowable modifier (therein the use of the 51), but I can't tell if all three codes can be used together. They are being denied, and this is the reason I'm asking.

I see the 52353 as including the lithotripsy, so 50590 shouldn't be reported....correct?

I am *really* hesitant about putting this question out there, but I'm in desperate need of help with this.

I think you can send me a PM here, too, and that might be the best way to do it? I do appreciate any and all help.

Hi Trina,

50590 contains components 52353 and 52320. The use of modifier 59 is allowed on 52353 and 52320 as long as the documentation supports it.

Good Luck
Laurie CPC
An operative note is really necessary to understand what is being done, as this code combo documents similar procedures.

50590 - Lithotripsy done by shock wave outside of the body
52353 - Lithotripsy done by shock wave inside of the body through a scope
52320 - Removal of ureteral stone through a scope

Using all three codes means ALL of the above are being done, which seems like overkill and explains your denials.
If pt had bilateral kidney stones, and a different method was used for each stone, then it can be billed using lt and rt modifiers to appropriate side, but if it was multiple approaches for the same stone, those codes could not be billed together. Normally, you would bill the most extensive procedure, which is 50590. Without the op report, I cant determine the circumstances of why he used all 3 codes.